Psychiatric foster homes as care in the community: the view of the community and relevant stakeholders

Background/Objectives: Due to an increasing trend towards deinstitutionalization and community care, people with psychiatric problems have the opportunity to receive care when needed in their own environment and maintain their societal roles. For those people for whom living in their own home is not an option, alternatives have been created to mimic living in the community as closely as possible. These alternatives can be considered on a range from more autonomous living to more care. Foster homes are a form of supported housing in which people with psychiatric problems live with a volunteering family in their home. It has its roots in Geel, Belgium, but has withered here in the past decades. Fewer people with psychiatric problems are choosing this form of care and fewer families are volunteering. The current study investigates the potential of psychiatric foster homes for providing care in the community, for integration in society, and for supporting users in their recovery.

Methods: Via an online survey, 63 health care professionals from the organising hospital, 29 health care professionals from other forms of care, 34 foster families and 112 inhabitants from the community were surveyed. Twenty-seven users in foster homes were interviewed in a personal interview.

Results: The majority of all stakeholder groups consider the users of foster homes well integrated in society (ranging from 76% and 96% of those interviewed). The users themselves are however only slightly less positive about their social integration in the community; 15% consider themselves as not well integrated. Some stakeholders also mention that ‘users fit in the community but are still looked upon as different’. Many social occasions are still organised by the psychiatric hospital (e.g. Sunday care, social café, hair dresser) which hinders creating friendships outside a circle of other users. Most users of foster homes are satisfied (89%) and feel they can build on living a useful and dignified life. They appreciate the freedom they have and reported they felt more at home than in the hospital. Foster families consider the user to be part of their family and are largely opposed to the idea of short-term stays. Some users do however feel the need to see this form of housing as a transition to a more autonomous life. This is not evident in the current organization of foster care. Users emphasize the need for choice: they are satisfied but would not consider it to be the best choice for everyone.

Discussion/Conclusions: The results indicate that foster homes are a fully-fledged form of supported housing which can offer a meaningful life to users. To aid in recovery, transitional use of this form of housing needs to be facilitated and true social integration requires further encouragement. General public awareness campaigns are still needed even in a town with a long history of community care for people with lived experience.

Funding: Federal Government Public Health, Food Safety and Environment.

Keywords: Recovery-oriented interventions, community participation, foster home care.